*Center for Vulnerable Populations †Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, University of California-San Francisco, San Francisco, CA ‡Division of Research, Kaiser Permanente Northern California §Kaiser Foundation Health Plan, Internet Services Group, Oakland, CA ∥School of Public Health & Community Health, University of Washington, Seattle, WA.
Med Care. 2014 Mar;52(3):194-201. doi: 10.1097/MLR.0000000000000069.
Online patient portals are being widely implemented, but their impact on health behaviors are not well-studied.
To determine whether statin adherence improved after initiating use of the portal refill function.
Observational cohort study within an integrated health care delivery system.
Diabetic patients on statins who had registered for online portal access by 2010. A total of 8705 subjects initiated the online refill function use within the study window, including "exclusive" and "occasional" users (ie, requesting all vs. some refills online, respectively). Using risk-set sampling, we temporally matched 9055 reference group patients who never used online refills.
We calculated statin adherence before and after refill function initiation, assessed as percent time without medications (nonadherence defined as a gap of >20%). Secondary outcome was dyslipidemia [low-density lipoprotein (LDL)≥ 100]. Difference-in-differences regression models estimated pre-post changes in nonadherence and dyslipidemia, comparing refill function users to the reference group and adjusting for age, sex, race/ethnicity, medications, frequency of portal use, and outpatient visits.
In unadjusted examinations, nonadherence decreased only among patients initiating occasional or exclusive use of the refill function (26%-24% and 22%-15%, respectively). In adjusted models, nonadherence declined by an absolute 6% (95% confidence interval, 4%-7%) among exclusive users, without significant changes among occasional users. Similar LDL decreases were also seen among exclusive users.
Compared with portal users who did not refill medications online, adherence to statin medications and LDL levels improved among diabetic patients who initiated and exclusively used the patient portal for refills, suggesting that wider adoption of online refills may improve adherence.
在线患者门户正在被广泛应用，但它们对健康行为的影响尚未得到充分研究。
确定在开始使用门户 refill 功能后，他汀类药物的依从性是否有所改善。
在一个综合医疗服务提供系统内进行的观察性队列研究。
在 2010 年之前已注册在线门户访问的服用他汀类药物的糖尿病患者。在研究窗口内，共有 8705 名患者开始使用在线 refill 功能，包括“专用”和“偶尔”用户（即分别在线请求所有或部分 refill）。使用风险集抽样，我们在时间上匹配了 9055 名从未使用过在线 refill 的参考组患者。
我们计算了 refill 功能启动前后的他汀类药物依从性，评估方法为无药物时间百分比（定义为＞20%的用药间隔）。次要结局为血脂异常[低密度脂蛋白（LDL）≥100]。差异-差异回归模型比较 refill 功能使用者和参考组在非依从性和血脂异常方面的前后变化，并调整年龄、性别、种族/民族、药物、门户使用频率和门诊就诊次数。
在未调整的检查中，仅偶尔或专用启动 refill 功能的患者非依从性下降（分别为 26%-24%和 22%-15%）。在调整后的模型中，专用 refill 功能使用者的非依从性绝对下降了 6%（95%置信区间，4%-7%），而偶尔 refill 功能使用者则没有显著变化。在专用 refill 功能使用者中也观察到 LDL 相似的降低。
与未在线 refill 药物的门户使用者相比，开始并专门使用患者门户 refill 的糖尿病患者，他汀类药物的依从性和 LDL 水平有所改善，这表明更广泛地采用在线 refill 可能会提高依从性。
